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BLUNT FORCE TRAUMA-Final PDF
BLUNT FORCE TRAUMA-Final PDF
Berti Nelwan
berti@indosat.net.id
• Guidelines for Reports by Autopsy Pathologists;
Vernard Irvine Adams, MD; Department of
Pathology and Cell Biology, University of South
Florida, Tampa, Florida, USA. 2008
• Textbook of Traumatic Brain Injury; Thomas
Genrelli MD. American Psychiatic. 2005
• Clinical ForensicMedicine3rd editionEdited by
W.D.S. McLay. 2009
• Blunt Force Trauma; Pathology Forensic Journal.
2010
Forensic Pathology
• Forensic Pathology is the branch of medicine
which analyses victims of crime scenes
medically.
• They are the last physician for the deceased
and their role is to discover and interpret the
evidence left during the autopsy.
Analysis of Wounds
Note:
The blunt force trauma may cause contusions and lacerations of the internal
organs and soft tissues, as well as fractures and dislocations of bony
structures.
• The major types of “cutaneous”
blunt force injuries are as follows:
– Contusion (bruise)
– Abrasion
– Laceration
– Avulsion
– Fracture
Bruises
• A bruise is "a hemorrhage into tissues
produced by the escape of blood from blood
vessels".
• Bruises may be found in the skin, muscles, and
internal organs.
Bruises
• Bruises are typically produced by a blunt force
impact, such as a blow or a fall.
• They may also be produced by squeezing or
pinching, where the force is applied gradually
and then maintained.
Contusions (Bruises)
Contusions are
discolorations of the skin caused by bleeding
into the tissues from ruptured blood vessels.
Important: Natural Bruises
• Bruises may occur in a variety of natural diseases in
which there is an abnormality of the clotting
mechanism of the blood, e.g. scurvy (vitamin C
deficiency), leukemia, alcoholic liver disease.
• This bruising is "spontaneous" because the injury
which produces it is so insignificant as to typically
pass unnoticed.
• The presence of such natural disease will exaggerate
the bruising effects of any trauma.
Problems with Skin Bruises
• Delayed appearance
• Ageing (relative)
• Site of Trauma
• Shape of object
• Degree of force
• Post-mortem bruises
• Post-mortem lividity
Classic Causes of Bruises
• Finger pad bruises: battered babies, manual
strangulation
• Different ages: repeated assaults
• Shoulders and arms: forceful restraint
• Wrists and ankles: dragging
• Inner thighs: forceful intercourse
• Chest: resuscitation
• Bruising is uncommon in Suicides
Bruises
• The extent of bruising is inversely proportional to the
sharpness of the impacting object.
• Bruises may be associated with other blunt force
injuries such as abrasions and lacerations.
• As a general rule bruising is not associated with
incised wounds or stab wounds where there is a free
flow of blood from the cut blood vessels rather than
leaking into the tissues.
Site of Trauma
• In contrast with abrasions, the location of a
bruise does not necessarily reflect the precise
point of injury.
• Leaking blood will follow the path of least
resistance and gravity.
Delayed Appearance
• Deep bruises may have delayed appearance at the
skin surface. Deep bruises may require as long as 12
or 24 hours to become apparent, and some may
never do so
• The more superficial the source of bleeding, the
sooner the discoloration will be seen on the skin
surface.
• In a living victim, a second examination in one or two
days may show bruising.
• In the dead, a further examination one or two days
after the original autopsy may show bruises which
were not previously seen and reveal previously faint
bruises.
Autopsy and Bruising
Bruising in Deep Tissue
1. Possibly life-threatening
2. Sometimes no external injury
3. Revealed in autopsy
Documenting Bruising
1. Photography
2. Notes
Degree of Force
• The size of a bruise is an unreliable indicator
of the degree of force causing it.
• However, a heavy impact is likely to produce a
large bruise and a light impact to produce a
small bruise.
• If bruising is slight, it is reasonable to assume
that the degree of violence was slight.
Determining Degree of Force in Bruise
Patterns
Location:
• Some areas of the body bruise more easily than
others. The face bruises more readily than the
hands.
• Bruising occurs more readily in loose tissues and
where there is a large amount of subcutaneous fat
• Bruising is less apparent where the skin is strongly
supported by fibrous tissue or if the muscle tone is
good.
Determining Degree of Force in Bruise
Patterns
• Age
– Infants and the elderly tend to bruise more easily than
young and middle aged adults.
– Infants have loose and delicate skin, and the abundant
subcutaneous fat.
– Elderly have degenerative changes in the tissues which
support the small blood vessels of the skin and
subcutaneous tissues.
• Gender:
– Women bruise more easily than men because they have
more subcutaneous fat and this is particularly true of
obese women.
• Natural Disease
• Skin color
Causitive Object
• The shape of the bruise is most likely to reflect
the shape of the causative object when the
object is small and hard and death occurs
soon after injury
Causitive Object
• A doughnut bruise is produced by an object
with a rounded contour (e.g. baseball).
• Two parallel linear bruises result from a blow
with a rod or stick
• Bruises can follow rounded contours if they
are caused by a flexible object like a lash
Causitive Object
• Bruises produced by fingerpads as a result of
gripping are usually larger than the fingerpads
themselves.
• The pattern and location suggests the
mechanism of causation:
– On the neck in throttling
– On the upper arms in restraint.
• Such bruises are referred to as patterned.
Aging of Bruises
•Color changes a bruise goes
through can give a rough estimate
of time of injury
•Colors result from breakdown of
hemoglobin from tissues
•Dark blue/purple (1-18 hours)
•Blue/brown (~1 to 2days)
•Green (~ 2 to 3 days)
•Yellow (~3 to 7 days)
red immediate
green days 4 -5
Yellow days 7 - 10
resolution days 14 - 15
Glaister:
violet immediate
blue day 3
green days 5 - 7
yellow days 8 - 10
resolution days 13 - 18
Polson and Gee:
red immediate
purple black soon after
green days 4 -5
yellow days 7 - 10
resolution days 14 - 15
Aging Bruises
• While accurate estimation of the age of a single
bruise is not possible, a fresh bruise can be
distinguished easily from one which is several days
old.
• Establishing that bruises are of different ages may be
of medical importance where there is an allegation
of repeated assaults:
– Child abuse
– Wife beating
– Where pre-existing injuries need to be distinguished from
those produced by a recent assault like a chronic alcoholic
who was assaulted.
Post Mortem Bruises
• It requires considerable violence to produce a bruise
post mortem or after death.
• These bruises are smaller relative to the degree of
force used.
• Post mortem bruises are most readily produced in
areas of hypostasis (post mortem lividity, livor
mortis) or where tissues can be forcibly compressed
against bone.
• A bruise can develop on the head after the body is
left lying on the back.
Post Mortem Lividity
(hypostasis, livor mortis)
• The settling, after death, of blood within the blood
vessels under the influence of gravity.
• This results in a purplish discoloration of parts of the
body that are lower while sparing areas of pressure
contact - contact pallor.
• The pattern and distribution of lividity distinguishes
it from bruising.
• A body found on its back has livor mortis on the
dorsal (back) side with pale areas where the bone
contacted the floor.
Postmortem changes on the chest caused by insect activity.
Patterns of Injury
• Bruises to the knuckles of the hands, together
with bruises of the eyelids, bridge of the nose,
cheeks and lips, suggest a fist fight.
• Bruising around the eyes (spectacle bruises)
may be produced by direct blows, but also
commonly result from a fracture of the base
of the skull, e.g. in vehicle collisions or
gunshot wounds to the head
• They may also follow blunt impact to the
forehead producing jolting of the eyeballs in
their sockets with tearing of small orbital
blood vessels.
Patterns of Injury
• Injuries in motor vehicle collisions almost
invariably include abrasions and lacerations as
well as bruises.
• Patterns of injury may allow reconstruction of
incidents involving pedestrians or allow
distinction between driver and front seat
passenger.
Patterned abrasion on the head due to impact by a motor vehicle.
Two contusions on the skin of the chest
• A contusion
on the arm.
BLUNT HEAD TRAUMA
• Blunt trauma to the scalp and face can produce contusions,
lacerations, and abrasions.
• Battle’s sign — a bluish discoloration of the skin behind the
ear that occurs from blood leaking under the scalp after a
skull fracture.
• Spectacle hemorrhage (raccoon’s eyes) — a discoloration of
the tissues around the eyes usually due to a fracture of the
skull.
There are three major types of hemorrhages which
occur in the skull.
The type of hemorrhage helps the examiner
understand what may have caused death.
berti@indosat.net.id